While many things can cause pain in your legs and feet, a commonly undiagnosed condition may be causing your problem. When your body lays down too much plaque (fatty buildup or atherosclerosis) in the arteries that run from your heart to your legs, you have a condition called Peripheral Artery Disease (PAD).
This buildup prevents the proper flow of blood to your legs and can result in and be a hallmark of many dangerous conditions including:
- high blood pressure that may be difficult to control
- heart attack and stroke
- kidney disease and kidney failure
- wounds and amputation.
Many of these dangerous conditions occur in the later stages of this disease. If caught early there are many steps you and your doctor can take to prevent them from developing or getting worse. That’s why it’s very important for anyone with diabetes, poor circulation, who is over 65, or has other risk factors to get evaluated for PAD at our office.
Risk Factors for Peripheral Artery Disease (PAD)
At the Foot and Ankle of Lake City, we’ll ask all our patients at risk for PAD to get tested for this condition so that treatment can begin right away.
What are the risk factors?
- Anyone 65 or older
- People with diabetes
- People with atherosclerosis in another location
- High blood pressure
- Smokers - tobacco use increases the risk for PAD by 400% and symptoms develop 10 years earlier.
- High cholesterol
- Family history
- Abdominal obesity
- Poor circulation
- Have a blood clotting disorder
Symptoms of Peripheral Artery Disease (PAD)
In Stage 1 of PAD, patients don’t have symptoms. Most PAD patients (75% of them) fall into this category. But just because the symptoms aren’t there doesn’t mean the disease isn’t dangerous. That’s why it’s so important to get tested and treated early.
If you are feeling any of the symptoms below, you’re at disease Stage 2 or later. It’s critical you’re evaluated so you can receive treatment. Many times symptoms won’t appear until arteries are 60% blocked.
- Burning or aching in feet or toes during exercise or at rest
- Cramping in the hips, thighs, or calf muscles after walking or a strenuous activity.
- Leg numbness or weakness
- Feeling cold in the lower leg or foot, particularly when compared to the other side.
- Shiny skin on the lower legs or color changes
- Wounds and frequent soft tissue infections
- No or weak pulse in legs or feet
Diagnosis of Peripheral Artery Disease (PAD)
Several tests will help in the diagnosis of PAD. Fortunately, one of those tests can be conducted in our office. That test is called the ABI or Ankle-Brachial Index. The frequency of testing in our office is based on the following:
Referring Patients with Peripheral Artery Disease (PAD) for Further Testing
Patients with an ABI of less than 0.7, a non-healing wound, or symptoms of aching or burning in the feet and toes will be referred to a vascular specialist for further testing. Testing may include:
- Pulse Volume Recording (PVR) – more accurately measures blood flow to your legs.
- Vascular Ultrasound – shows narrowed or blocked arteries.
- Exercise Stress Test – measures blood pressure in your lower legs and feet before and after exercise.
- Angiogram – an invasive test that uses X-rays to identify specific blockages.
Treatment of Peripheral Artery Disease (PAD)
The earlier treatment for Peripheral Artery Disease (PAD) begins the less invasive the treatment. The treatments can include:
- Behavior change
- Wound management
- Procedures and surgery
Behavior change in five key areas can greatly reduce your risk of developing the dangerous conditions described above.
- Reduce or stop smoking – smoking greatly increases risk for cardiovascular disease and stroke. Our state has the Washington State Quit Line which has helped millions of Washingtonians quit.
- Eat a heart-healthy diet – eating a diet rich in fruits and vegetables and whole grains and low in fat can help reduce your risk by lowering your cholesterol levels. Cholesterol is the substance that lays down the fat in your arteries. Other important recommendations include eating low-fat or fat-free dairy products, eating poultry and fish, and limiting red meat, salt, and sweets.
- Exercise – exercise will help increase your blood flow. If you’re having pain in your legs, you should consult with your doctor about having supervised exercise. Otherwise walking and biking are excellent exercises to begin. The American Heart Association recommends at least 30 minutes of exercise three times a week. Be sure to wear supportive shoes when walking or running. Your doctor will need to approve any new exercise program you do on your own.
- Weight management – weight loss is also important for patients who are overweight or obese. A combination of eating a heart-healthy diet, portion control, and exercise are the basis for a weight management program.
- Reduce stress – learning to manage stress, get good sleep, and deal with life problems can help with your physical health.
- Controlling high blood pressure – high blood pressure is controlled through medications, eating a heart-healthy diet, reducing sodium intake to 15000 mg/day, limiting alcohol, and regular exercise.
Medications for Peripheral Artery Disease
Your doctor may also prescribe specific medications to treat PAD and prevent complications. These may include:
- Blood pressure medication – can lower blood pressure and prevent blood vessel from becoming narrow.
- Anti-platelet medication – these medications can prevent blood clots from forming and improve your symptoms.
- Statins – statins lower your cholesterol and some fats in your blood. These can help prevent plaque from building up in your arteries.
Our office will help you prevent and manage foot or ankle wounds or ulcers. Learn more about foot ulcers here.
Procedures and Surgery
If your PAD is more advanced your doctor may order some special procedures or recommend surgery. These may include:
- Angioplasty – this procedure can open up blocked or narrow arteries. Often a stent is then placed in the artery to keep it open.
- Heart Bypass Surgery – if angioplasty and stents aren’t likely to work, your physician may refer you to a surgeon for heart bypass surgery.
- Amputation – if a wound has progressed to the point where the tissue begins to die due to lack of access to blood, you may need an amputation.